Provider Demographics
NPI:1629322656
Name:SUTHERLAND, JOY KIMBERLEE
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:KIMBERLEE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:KIMBERLEE
Other - Last Name:KAOPUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6650 W WARM SPRINGS RD
Mailing Address - Street 2:UNIT 2156
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4602
Mailing Address - Country:US
Mailing Address - Phone:702-325-7219
Mailing Address - Fax:
Practice Address - Street 1:6650 W WARM SPRINGS RD
Practice Address - Street 2:UNIT 2156
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4602
Practice Address - Country:US
Practice Address - Phone:702-325-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health